Influence of diabetes on natriuretic peptide thresholds in screening for Stage B heart failure

Abstract

Abstract:Context Natriuretic peptide (NP) has been shown to be an effective screening tool to identify patients with Stage B heart failure and to have clinical value in preventing heart failure progression . The impact of associated metabolic confounders on the screening utility of NP needs clarification. ObjectiveTo assess the impact of diabetes (DM) on NP screening for asymptomatic Stage B heart failure. Materials and MethodsThe study population consisted of 1368 asymptomatic patients with cardiovascular risk factors recruited from general practice as part of the STOP-HF trial. B-type NP (BNP) was quantified at pointof-care. ResultsBNP was found to be as accurate for detecting Stage B heart failure in DM patients compared to non-DM patients (AUC 0.75 [0.71,0.78] and 0.77 [0.72,0.82], respectively). However, different BNP thresholds are required to achieve the same level of diagnostic sensitivity in DM compared with non-DM patients. To achieve 80% sensitivity a difference of 5ng/L lower is required for patients with diabetes. ConclusionAlthough a significantly different BNP threshold is detected for patients with DM, the BNP concentration difference is small and unlikely to warrant a clinically different diagnostic threshold.3 Background:

Diagnostic accuracy of point-of-care natriuretic peptide testing for chronic heart failure in ambulatory care: systematic review and meta-analysis

“…Five of the studies were in a primary care setting (two assessed BNP and three assessed NTproBNP). 23 24 25 26 27 Two studies gave data for confirmed CHF cases. 28 29 Seven studies had a case-control design, and 32 were cross sectional/cohort studies, 15 of which had populations presenting mainly with dyspnoea, six had populations with several signs and symptoms of CHF, five had populations of echocardiography referrals, two had populations with cardiovascular risk factors, two had populations with stable CHF referred for cardiac rehabilitation, one had a population with acute coronary embolism, and one had a non-cardiac population receiving mechanical ventilation (see supplementary table S1).…”

“…The reported sensitivity and specificity varied considerably between studies. The lowest sensitivity came from one study on a primary care population with very low prevalence of CHF (19%) 27 and two studies on inpatient and outpatient populations that used BNP thresholds >345 pg/mL. 30 31 …”

“…At a threshold of <100 pg/mL, sensitivity ranged from 0.46 (95% confidence interval 0.32 to 0.61) to 0.98 (0.93 to 1.00) and specificity from 0.31 (0.22 to 0.41) to 0.98 (0.95 to 1.00). The two studies 23 27 in a primary care setting reported sensitivities ranging from 0.46 (0.32 to 0.61) to 0.92 (0.81 to 0.98) and specificities from 0.38 (0.31 to 0.46) to 0.82 (0.79 to 0.85) at a range of thresholds <100 pg/mL (10-50 ng/mL). The study by Watson et al, 27 which reported the lowest sensitivity, included a population with a low prevalence of CHF (19%) as it included patients with risk factors for cardiovascular disease, not with symptoms of CHF.…”

NTproBNP in insulin-resistance mediated conditions: overweight/obesity, metabolic syndrome and diabetes. The population-based Casale Monferrato Study

“…Therefore, the effect of diabetes prevailed on that of BMI and NTproBNP values were reduced in people with both diabetes and overweight/obesity, pointing out the existence of a likely natriuretic handicap even in diabetic subjects [ 23 ]. Consistently, different BNP threshold have been identified in diabetic compared to non diabetic patients to maintain equivalent accuracy in screening for stage B heart failure [ 47 ].…”

Point-of-care testing of (N-terminal pro) B-type natriuretic peptide for heart disease patients in home care and ambulatory care settings

“…Namely, their threshold is a point to be discussed. The findings from the five studies on primary care (which were excluded from the present review because the clinical outcomes were undescribed [ 5 , [16] , [17] , [18] , [19] ]) in a review article to assess the diagnostic accuracy of BNP/NT-proBNP POCT [ 4 ] might be useful to consider a reference level. Of the five studies, three studies [ 5 , 16 , 17 ] using NT-proBNP showed a sensitivity of 0.99 and specificity of 0.60 ​at a threshold of 125 ​pg/mL.…”